You Give Docs A Bad Name

Audacity hardy begins to describe this physician. In the latest article from the New York Times on who is to blame for the U.S.'s enormous healthcare costs (they usually blame the MD's), the paper writes about unexpected medical expenses following a hospital stay. This time, they document the difficulties of a young man who just had neck fusion surgery.

Even before they talked about the outrageous bill that blindsided this patient, they itemize the enormous costs of having surgery that were anticipated in advance: $56,000 from the hospital, $133,000 from the orthopedic surgeon, a relatively measly $4,300 from the anesthesiologist. I think most Americans would be shocked by these expenses, much less the rest of the single payer world. The man knew that his insurance company will only pay the prenegotiated reimbursements since these were all within his network. But then, much later, her received a bill for $117,000 from an assistant surgeon that he never recalled meeting.

The primary surgeon, Dr. Nathaniel Tindel, was eventually reimbursed $6,200 by the insurance company. The assistant, a neurosurgeon by the name of Dr. Harrison Mu, was out of the insurance network. Therefore he could bill for whatever he felt was his going rate. This despite the fact that he was duplicating the work that was already performed by Dr. Tindel. Dr. Tindel billed the insurance company $74,000 for removing two vertebral disks and $50,000 for inserting the hardware. Dr. Mu billed for the exact same procedures at a rate of $67,000 and $50,000, respectively.This sounds suspiciously like double dipping to me. Not a bad payday for about two hours of operating time.

I've seen these situations in the OR's before.When the economic times were tough a couple of years back, we had plastic surgeons scrub in and just stand around holding retractors until they were needed for skin closure. I'm sure they billed a pretty penny for that beautiful pencil thin scar. You have to wonder about any possible financial arrangements that were made between the primary surgeon and the assistant. After all, why share the work with another doctor if it is much cheaper to just use the PA or resident?

Another highly questionable aspect of this situation is that the patient denied ever meeting Dr. Mu. Was Dr. Mu's name on the surgical consent? Around here, if the name is not on the consent, the doctor does not touch the patient, period. That even applies to the surgical residents and fellows in the operating room. Anything else could be construed as an assault by the doctor on the patient.

The paper tries to justify Dr. Mu's actions based on his normal hospital practice, which is in Jamaica Hospital Medical Center in Queens. According to state records, his practice mostly involves trauma patients on Medicaid, which probably pays him about one percent of what he billed in this spine case. Therefore, even though Dr. Mu is the chief of neurosurgery at Jamaica Hospital, he has to find time to moonlight at other places to make ends meet.

In the end, the insurance company coughed up a $117,000 check for Dr. Mu. The patient, who was reluctant to pass the check along to the surgeon for fear of setting a bad example, ultimately mailed it to him rather than getting into a legal tangle with the doctor. And Dr. Mu will now be forever known to the world as the neurosurgeon who makes Gordon Gekko look like Mother Teresa.